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Hi Im 22, tested poz at the end of June. The last month has been hard, but been busy with school and working, so I got through it. I just finished my last class for a degree on Friday and now have to start looking for a real job. Whats hard is that my student health insurance runs out next month and I would have to get a COBRA plan and pay for my own insurance from there. I got tested at the public clinic in the city, and they have had me go to public hospitals and told me I would be covered under the RYAN WHITE plan there, and maybe could apply for public insurance assistance there. I am not sure if I should try to pay for my own insurance and stay covered that way, or just rely on their public services. I plan on moving away from the area as well soon, want to start over and get my life together (have wanted to move for years, but stayed to finish school, didnt think id end up with this) Get my first counts on Monday, am a little scared they might be bad.

Is your line of questioning more along the lines of whether having private insurance is more likely to result in better care than a public health clinic. Maybe, maybe not -- depends on the clinic and quality of doctors there. I saw private doctors for 11 years, but have gone to a public clinic for the past 5. My care at the public clinic is as good if not better than when I had a private doctor, but maybe I just lucked out.

This isn't the type of question that can effectively be answered on an internet forum where nobody knows where you live and/or what clinic you're referring to. Do you know any local people with HIV that can give you some input on this?

Also, if you don't currently have a job and the income to pay out of pocket for an insurance policy then I'm not sure what the point is anyway, but maybe you have some resource you're not referring to lined up.

Thanks for the reply. Ive talked to a couple of people and some told me the difference isnt that big between a private doctor and a public clinic. The social worker told me that I wouldnt have a good chance getting private health insurance as it would be considered a pre-exisiting condition. Moneywise I have some savings, but it wouldnt necessarily be easy trying to pay off a plan. Im healthy otherwise though, havent had any other health problems. Someone also suggested to me that I do try keep myself insured with no gap period, and then just get retested with a private doc in a couple months and get my care covered with the private company. Just worried I might be putting myself in a bad position if I dont continue with a private plan and instead rely on public clinics. I live in California near SF BTW.

Im with Miss P - your questions are a few, complicated, and how do we know the particulars of your situation?

How much would cobra cost? And how much for an individual private plan?

Don't you need your savings to start out in life, find a job, etc?

If I were in your shoes, I would wait for your numbers, see what the immediate need and cost is for any possible HIV treatment.

If the social workers can garantee that you'll get HAART if needed, without having private insurance, then go with public, put HIV in its proper bracket,and put your time and money and attention into finding your job, new adult life, etc etc.

Logged

ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Sorry for the vague question, just not sure really sure who I can talk to. I havent really researched how much it would cost for a private individual plan. My social worker pretty much just told me that it would be extremely hard to get coverage now, and even then Im not in a very good financial situation and a better quality of care couldnt be guaranteed. Id rather use my savings on something else too, I just don't want to put myself into a bad situation for now or in the future when I will need meds.

Hmm Im with you then. Wait and see with your HIV numbers.Fight for a job. Get an apartment. Maybe your job will come with insurance. Maybe Washington will soon deliver some reform - I hear that preexisting clauses may be out. Maybe there will be more official and secure public options...

Logged

ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Um, hang on. I know I don't have to deal with American health insurance, but I've learned a few things in my time on these forums.

Isn't it true that if you have an existing insurance plan, lose it, then go onto COBRA, that you don't have to worry about pre-existing conditions? Isn't that part of the point of COBRA, in addition to financially helping bridge the gap between policies?

Please correct me if I'm wrong, and if I am, I'll go back into my corner and shut up.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Ann, while obviously it's been eons since I was in college, I can't rightly recall that when I was there it was "technically" an insurance policy or if it was just something where it seemed like it was. By that I mean a policy with an independent company. So I don't even think COBRA applies in such a situation, unless things have changed since I went to college. In fact I rather recall that during the lapse from graduating college to my first job my parents actually put me back on their policy. Perhaps this is why the social worker is saying what she is saying.

Anyway, the bottom line is that this individual doesn't really have the money to pay for the policy without digging into savings -- that is not a great choice. If he is in the Bay Area, with it's substantial HIV population, I would assume that the clinic setting is similar to what one finds where I live and that the care is fine. Generally in a clinic the issue isn't necessarily the quality level of the doctor, but the quality level of the operation/support staff that can be annoying. And many people don't like clinic settings because they don't like sitting in the waiting room with poor folks, sad to say but I've heard what I'll only call "veiled comments" about this in support groups.

Also, if the clinic is set up appropriately, dshrfrshr would have an in-house assigned case manager for all of his non-medical needs such as getting him on ADAP quickly should he need medication and assess what other services are available, and possibly have support groups, etc.

Ann, while obviously it's been eons since I was in college, I can't rightly recall that when I was there it was "technically" an insurance policy or if it was just something where it seemed like it was. By that I mean a policy with an independent company.

Hmmm.... good point. My daughter had to take out health insurance during her year of college at Miami U and I'm pretty sure it was an independent company. Of course, that could well have been because she was classed as an "out of state" student. (not a "foreign exchange" student, because she travelled on her US passport) I'd ask her but she just this minute left for a hot date. (lucky her!) I'll try to remember to quiz her next time she's in the house.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

My university was actually half of a large medical college, so IIRC students were just covered for service under that umbrella. I guess my larger point is that with medical stuff on a campus it's not always what it seems.

Um, hang on. I know I don't have to deal with American health insurance, but I've learned a few things in my time on these forums.

Isn't it true that if you have an existing insurance plan, lose it, then go onto COBRA, that you don't have to worry about pre-existing conditions? Isn't that part of the point of COBRA, in addition to financially helping bridge the gap between policies?

Please correct me if I'm wrong, and if I am, I'll go back into my corner and shut up.

Ann

You're right. The real expert on all of this is madbrain, but basically you're right.

The OP says he has the option of COBRA so I do think a college insurance plan would likely qualify for what's called "creditable coverage" under HIPAA rules. If you have uninterrupted creditable coverage then limitations for pre-existing conditions can't be imposed.

It seems a private plan is better in terms of covering all matters related to your health, since public assistance for HIV, such as ADAP, only covers meds and Ryan White Part B covers HIV-related issues but what if a person needs care related to other things that are not directly tied to HIV? But not all private plans are the same, the OP should check and see what his college plan covers.

Assuming the OP is young, the cost of COBRA should not be too high, the rates are based on whatever the previous coverage was, so in his case it would be whatever was being paid by the college. And since rates for policies are based on age, I would guess his college was not being charged that much per student. The other thing to consider is what the college policy covers, maybe it has a high deductible etc? The COBRA policy would cover the same, it's basically an extension of one's previous policy.

If his numbers are excellent and he does not need to go on meds, pre-existing conditions are limited to a maximum of 12 months so that's also something to consider (i.e. lose coverage for now, get new coverage with an employer and hope that he does not have to go on meds during the period of time, no longer than 12 months, that the pre-existing limitations apply). I believe the length of time pre-existing conditions can be applied is based on how long the person did not have creditable coverage. So for example if he loses his insurance for 6 months and he starts a job that offers insurance, the new insurance can impose a 6 month time period during which pre-existing conditions apply (since that's the amount of time he did not have coverage).

I think the OP also needs to get some sort of certificate that confirms his coverage at the college, this is used to establish creditable coverage later on.

If madbrain sees this thread, I'm sure his expert advice would be welcomed.

To the OP: You might want to send a PM to Madbrain, he is a member of the forums who has a lot of knowledge about these matters.

PS: I'm surprised the social worker seems to have given him incorrect information. The only way what the SW would be correct is if the college plan does not count as creditable coverage, which I think is highly unlikely to be the case.

Um, hang on. I know I don't have to deal with American health insurance, but I've learned a few things in my time on these forums.

Isn't it true that if you have an existing insurance plan, lose it, then go onto COBRA, that you don't have to worry about pre-existing conditions? Isn't that part of the point of COBRA, in addition to financially helping bridge the gap between policies?

Please correct me if I'm wrong, and if I am, I'll go back into my corner and shut up.

Ann

Ann: Naaaah; don't shut up! Your NOT wrong.

COBRA option means NO DENIALS because there is so application process.[/u] It's the same coverage renamed (sorta) and for lots of your green (no longer subsidized by employer/school).

---A school policy is probably low coverages/lowest premiums. I'd try to get something comprehensive. Realize that COBRA allows your present insurer to restrict you switching to any plan they offer not offered your old group. So, I'm glad my own CALCOBRA is ending this month.

---New private insurance might mean 6 month (MAX) "pre-existing condition" denial, but NOT FOREVER. Anyone? I have been told I was being denied for 6 months (in error) and then been offered coverage immediately. A good example of how confused insurers are, not just how confusing the "system" is.

---HIPPA applies, along with other (state) laws, for all the US.

Congratulations on your degree! Dumb patchwork "system" makes all this complicated. Maybe a great new job in a new city will be your best bet. Meanwhile? I'd look at every option, public especially, not just jump on COBRA (I think I've had it 5 times now).

Informing yourself---as you are--is a good way to proceed.

Feel free to "PM" if you'd like. -megasept PS Washington DC is working out "health insurance reform", not "healthcare reform".

Hi everyone, thanks for the help. I'm debating trying to meet with some health advisors from my school's health program tomorrow for guidance on post-college health insurance. Should I not tell them that I recently tested positive? Im guessing it would be better not to at this point. Im not positive I can enroll in a COBRA plan, but if not, I think I could qualify for another plan. I'm also having problems since I was tested in San Francisco, but I am not technically a city resident (I dont have an apt lease or anything there), so I dont believe I qualify for any of their public services. I have an appt on Monday with both a doctor and a case worker, but I might cancel it now, just to try and figure some of this out.

By all means talk to the doctor and the social worker. You need all the professional advice you can get. We've all seroconverted. You have a lot to learn its a a really stressy time now. So professionals will have a cool view on the stategies.Seems also a good idea to see a doc who can get you some numbers on your HIV.

Logged

ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Hi Im 22, tested poz at the end of June. The last month has been hard, but been busy with school and working, so I got through it. I just finished my last class for a degree on Friday and now have to start looking for a real job. Whats hard is that my student health insurance runs out next month and I would have to get a COBRA plan and pay for my own insurance from there. I got tested at the public clinic in the city, and they have had me go to public hospitals and told me I would be covered under the RYAN WHITE plan there, and maybe could apply for public insurance assistance there. I am not sure if I should try to pay for my own insurance and stay covered that way, or just rely on their public services. I plan on moving away from the area as well soon, want to start over and get my life together (have wanted to move for years, but stayed to finish school, didnt think id end up with this) Get my first counts on Monday, am a little scared they might be bad.

First, sorry to hear about your recent diagnosis. It is always a difficult thing.I would strongly recommend that you elect COBRA . I know it is not cheap, but it is really worth it to have full private insurance coverage.

I live only 50 miles south of you, in Santa Clara. My bf was initially seen in public hospitals. The difference with private insurance which he now has was huge. At the public hospital in San Jose, the doctor was writing down his labs on a piece of paper. There were no computers to store them. No copies for the patient - only verbal reading (and misreading) of those notes, which led to misunderstandings. My bf never knew he had an AIDS diagnosis when he first tested poz, until I started going to the doc with him and looking at his labs. When his CD4s dropped quickly to 230 in Jan 2007, the doctor wanted to put him on meds right away. This required a genotype test to choose his meds. But there were no funds to do a genotype test because apparently they were out of Ryan White funds while it was being reauthorized by congress. It took a complaint letter to the Santa Clara county supervisor, and 2 months, to get his genotype test done and him started on meds when he needed them. The week of the followup after he started meds, we had to wait 3 hours for the doctor, who had gone away on an outcall, without advance notice to us or cancellation. Unfortunately, my experience is not isolated - I know many others who are now at Kaiser and were in the public system before, and they all have horror stories to share about it.

To put this in perspective, at Kaiser, the very first day that I tested poz, they ordered my CD4, VL, and genotype all at the same time, as a matter of standard protocol. It turned out I didn't need the meds at the time (and still don't), but if I had, my doctor could have chosen my meds as soon as the genotype came back, which was about 2 weeks later. I get regular detailed printouts of all my labs in the mail.

Now, I have heard that the public system in SF for HIV/AIDS is much better. I certainly hope so. But since you are planning on moving out of the area, this is probably not what you want to rely on long-term.

If you are moving somewhere else in California, consider the recent budget cuts to Ryan white care made by the governator as a line-item veto, which in particular will stop paying for viral load, and genotype tests ! The only thing that will remain funded is ADAP. This is really not a time you want to be relying on the public system if you don't have to.

Also, Ryan white and ADAP only covers HIV/AIDS related issues. If you need surgery, have the flu, or anything else, you are not covered. It is not comprehensive health insurance.

What I would do in your case is check with HR the exact date your current plan ends. From then on, you have 60 days to elect COBRA. Make sure you don't let that time lapse ! You are still covered in the 60 days even if you haven't elected COBRA yet. You can pay the COBRA premium afterwards, as long as it is before the 60 days are up.The only exception to my recommendation to elect COBRA is if you get a job with a new health insurance plan before your 60 day COBRA election period is up.

Whatever you do, don't apply for an individual health plan. You will most likely be denied due to pre-existing condition, and even if you are accepted, you will probably be charged astronomical rates - much higher than what your COBRA premium would be.

Welcome to the forums. I live in NY and had my own business with its own plan. I also work for an employer. When I tested pos, I actually was in the process of switching plans for the company and had let the plan lapse and was not eligible to renew without the pre-existing conditions clause.

This put me in a bad spot. So I went to my employer and purchased insurance. That plan allowed me to go on without the lapse taken into account. I later found out that I can also get chamber of commerce insurance by joining and also not being subject to the pre-existing conditions clause. All members are in a stable group which hasn't "lapsed" its policy and allow new members to join. It would be the equivalent of a new employee starting and getting coverage right off the bat. I don't know if this is a NY State deal or what but it is worth asking your next employer if u might be in this situation.

Ask when applying for a new job if their plan cpvers new employees for "pre-existing conditions". You should be able to ask the plan without getting your HR person involved.

The CAA option with Blue Shield looks like it might be the best since he is eligible and has no medical underwriting. The pricing is confusing - 2% discount for alumni, but up to 125% of standard rate premium ?!

The other one is Anthem Blue Cross PPO 2500. The premium is not too horrible ($343/month under 30 yo), but the $2500 annual deductible is bad, and 30% coinsurance makes it even worse.

It doesn't matter since the school offers the OP several insurance options without medical underwriting.

I'm just saying as far as "creditable coverage" and COBRA. If a college student has their parent's insurance doesn't it count as creditable coverage under HIPAA and allow them to get COBRA? I think I read somwhere that it does.

I'm just saying as far as "creditable coverage" and COBRA. If a college student has their parent's insurance doesn't it count as creditable coverage under HIPAA and allow them to get COBRA? I think I read somwhere that it does.

It probably would count, but it doesn't matter since he is not currently on a COBRA-eligible plan.

Can you imagine if the government required every institution of higher learning to offer to extend coverage under COBRA? On the face of it this just would be crazy.

COBRA by definition implies past employment as a qualification.

Well, imagine a population that all has different benefits at changing costs and access to healthcare based on where they live, where they work, what their employer purchases or doesn't buy for them, their wealth, their health, etc. Oh...That's the existing "system". I hate COBRA, and sure it's designed for terminated employment. What wouldn't be crazy would be extending healthcare for all Americans based on the VA, or medicare models, for the entire population. Don't hold your breath.

Can you imagine if the government required every institution of higher learning to offer to extend coverage under COBRA? On the face of it this just would be crazy.

COBRA by definition implies past employment as a qualification.

Health insurance for people who are college age is not that expensive. If you have a big enough pool, as even mid-sized colleges have it's not that big a deal as far as the premiums, which are basically based on a person's age. Plus, doesn't the individual pay for COBRA once they leave the job? It's not the previous employer who is paying for it. So it would not be the colleges or universities paying for COBRA, it would be the students themselves, as a safety net, until they became employed.

I'm actually very surprised that college health insurance, at least in the case of the OP, doesn't count as "creditable coverage" under HIPAA. I think it's because many (most?) college students are still under their parents' plans, which would qualify as such.

So it would not be the colleges or universities paying for COBRA, it would be the students themselves, as a safety net, until they became employed.

IIRC with COBRA you reimburse the employer, plus 2% for administrative burden -- the covered person doesn't just send the payment into the insurer themselves. I was not implying that universities would be paying it. As someone who has actually used COBRA I already know how it works. My comment was meant in a logistical sense.

I assume that this is the same reason that there's no mandate that places of employment with less than 20 employees do COBRA.

IIRC with COBRA you reimburse the employer, plus 2% for administrative burden -- the covered person doesn't just send the payment into the insurer themselves. I was not implying that universities would be paying it. As someone who has actually used COBRA I already know how it works. My comment was meant in a logistical sense.

I guess it's possible but I find it hard to believe that it would be to much of an administrative burden or a logistical problerm for colleges and therefore, they should be spared this....at the expense of people going uninsured if they need it? When you consider that this is a population that's on average very healthy because of their age, we're not even talking that many people who would probably elect to take COBRA anyway (hence not such an administrative burden). But those few such as the OP who get HIV, or get anything else are screwed? Most institutions of higher learning have decent infrastructures and could handle something like this logistically.

I'm not claiming to know what the reason is that, it seems, college health coverage doesn't qualify one for COBRA at least in the OP's case, do we know if it's the same across the board? I don't know the full story here, but saying that it's probably because it would be too much of an administrative burden just doesn't seem logical to me. Not saying that it's not the reason, just saying that it would surprise me if it were.

I guess the only protection college students have as far as COBRA is to stay under their parents' insurance if they are able to do that, since that would count as creditable coverage and allow them to get COBRA when the times comes.

Where are you planning on moving, btw? Because I'm in the EXACT same situation-22, work, school, and my jobs don't have health insurance yet. BUT alot of states use Ryan white to cover COBRA premiums. So talk to your social worker about that, that's what happened with my premiums when I left my job with my health insurance. it's actually cheaper on their part to cover the premiums, than to cover everything. It is, of course a temporary fix. So you should actively continue seeking health insurance, but COBRA will last for 12-18 months? I believe?

COBRA lasts 18 months but since employers make new hires wait different amounts of time (ie ,<30 days, 3 months, 6 mos) before benefits kick in, they kick people OFF insurance plans at different times post-termination. So yeah, in effect, it's 12-18 months, depending on the "front-end" approach. A little confusing.

In California, 18 mos CALCOBRA follows (Fed) COBRA. Most states have nothing like it.

Madbrain, I have private insurance, Blue Cross, Blue Shield, "gold plated" through my employer, yet I go to a Public Hospital where the care is extraordinary. It's the ID clinic for Western New York, so I don't understand the differentiation between public and private. I can't imagine my doc treating someone with different insurance any differently.

Madbrain, I have private insurance, Blue Cross, Blue Shield, "gold plated" through my employer, yet I go to a Public Hospital where the care is extraordinary. It's the ID clinic for Western New York, so I don't understand the differentiation between public and private. I can't imagine my doc treating someone with different insurance any differently.

You must have a PPO insurance plan which offers you the choice of where to get seen.

The case I was talking about earlier was someone without insurance - my bf didn't have any at the time he was diagnosed with HIV and AIDS. He went to the San Jose PACE clinic and got services covered under Ryan white. He got the very bad experience I described. I am not sure if that clinic accepts people with insurance, I think it serves only uninsured people.

Hi everyone, thanks for the help. I'm debating trying to meet with some health advisors from my school's health program tomorrow for guidance on post-college health insurance. Should I not tell them that I recently tested positive? Im guessing it would be better not to at this point. Im not positive I can enroll in a COBRA plan, but if not, I think I could qualify for another plan. I'm also having problems since I was tested in San Francisco, but I am not technically a city resident (I dont have an apt lease or anything there), so I dont believe I qualify for any of their public services. I have an appt on Monday with both a doctor and a case worker, but I might cancel it now, just to try and figure some of this out.

Welcome to the forums.

It's really confusing when you are first diagnosed to get a handle on all the information out there, especially while you are trying to deal with all the emotions that come with a diagnosis. With everything coming at you at once it can be hard to set priorities, but I'm a little concerned that you might put off seeing a doctor while you think about how to get health insurance in the future.

Your first priority should be your health. It is important that you find out whether you need to start medications in the near term in order to protect your health. As a 22 year old just finishing college in the year when health care reform may change everything your health insurance options are not likely to stay the same -- but as long as you stay healthy you can probably adapt and find something that works for you. The most likely venue for health insurance at your age is to find a job that comes with health insurance benefits. But it will be hard to find a job if you get sick.

So your first priority should be to find out whether you need to start medications now to preserve your health or whether you will likely have a few years before you start. Only a doctor can tell you that information. Once you know that information you can look into jobs with benefits, grad school, other coverage options etc. But, with HIV, knowledge is power -- don't avoid seeing a doctor and finding out more about your current health because of future concerns about how you will finance treatment -- at your age it will all change a few times in the next couple of years anyway.

...So your first priority should be to find out whether you need to start medications now to preserve your health or whether you will likely have a few years before you start...Once you know that information you can look into jobs with benefits, grad school, other coverage options etc...at your age it will all change a few times in the next couple of years anyway.

Best wishesAssurbanipal

I totally agree...Start with best healthcare you need now, and good options (like group plan from new employer) will fall into place. Life will continue and progress as you pursue your interests and dreams.